Medication Security

1. Medication Security 12/9/2010

2. Maintaining Med Closet Security

3. Med Closet Keys Each medication closet will have 3 keys: • cottage key • back-up key kept in Health Services • back-up key kept by Residential Supervisor

4. Key Storage • Keys are kept on the responsible medication cleared staff at all times unless locked • When not held by the responsible medication cleared staff they are locked in the wall mounted locked box

5. Under NoCircumstances: • May keys leave the cottage • May keys be left in a drawer • May keys be left unattended and unlocked • May additional keys to med closets or cabinets be made • May non-med cleared or authorized staff have access to the keys (includes med cleared staff who are not authorized to give meds in your cottage)

6. What if keys are lost or locked in med closet by accident ? • If a nurse from Health Services or your Residential Supervisor is on campus they can help you access the med closet • If none of the above are present, call the AEC; they will be able to access back-up keys

7. Missing Keys Immediately contact: • Either the Director of Health Services or the Nurse On-Call And • Your Residential Supervisor

8. Lock Box Codes Can only be changed by: • Director of Health Services • Program Nurse • Residential Supervisor Under no circumstances: • May the codes be shared with anyone who is not authorized to give meds in your cottage • May the codes be left in a place where unauthorized staff would have access to the codes

9. Countable Controlled Medications

10. Common Examples of Countable Controlled Meds • Ativan (lorazepam) • Valium (diazepam) • Diastat (rectal diazepam) • Klonopin (clonazepam) • Xanax (alprazolam) • Ritalin (methylphenidate) • Focalin (demethylphenidate) • Concerta (methylphenidate sustained release) • Phenobarbital • And more, ask your program nurse if unsure

11. Special Requirements • Stored under a double lock • Two Person Counts done every 24 hours • One Person Counts are done on shifts without 2 Person counts • Counted every time it is poured • Certain countable meds are stored in Health Services, such as PRN meds for dental/medical appointments

12. Why do 2 Person counts ? • Quickly identifies if there is a possible drug loss or diversion. • Doing it consistently and correctly is for your protection. • It is required by the Department of Public Health. +

13. Two Person Counts • Done by 2 med cleared staff, 2 nurses or 1 of each • Done together • Together match the count of the medication with the number listed in the Countable Controlled Substance Book • Together verify the count and sign the Book • Must be done at least once every 24 hours

14. One Person Counts • Count is done and updated every time the medication is poured • Done on the shifts without a 2 person count • Done daily for Diastat

15. What to do if the count is not correct ? • Re-count with a second med cleared staff or nurse, Check back of blister packs • Look for obvious and correctable reasons such as the count was not updated the last time it was given • Immediately contact the Director of Health Services or Nurse On-Call and Residential Supervisor

16. New Countable Meds and Refills • Checked immediately upon arrival in Health Services or Cottage • Two person count done as soon as possible (no later than end of shift) • If delivered to Health Services 2 Person count includes a nurse and med cleared staff • New countable meds delivered to cottage: call Nurse On-call and 2 med cleared staff do 2 Person count • Refills of countable meds delivered to the cottage: notify program nurse so a nurse is included in a 2 Person count on the next working day for Health Services

17. Sending Countable Meds Home for Weekends or Recess • 2 Person count is done the day the student leaves for the weekend or break • 2 Person count is done the day the student returns • Adjust the count to 0 when the countable med supply is sent home and re-enter count upon return • 2 Person count is suspended until student returns with countable meds • If necessary ask a med cleared staff from another cottage or nurse to assist with the 2 Person count

18. Countable “Seizure Rescue Medications” Includes but not limited to Diastat, Klonopin, Ativan • Meds kept present with student at all times • Protocols must accompany medications • Diastat: 1 Person count done daily by CRL/ACRL and documented in Countable Controlled Substance Book • Klonopin, Ativan or other countable oral/g-tube meds: 2 Person count at least once daily

19. Non-Countable“Rescue Medications” Such as asthma inhalers, Epi-pens, Glucagon, steroid stress meds • Meds kept present with students at all times • Must be checked by CRL/ACRL daily • Protocols must be accompany medications • Do not require a 2 Person count

20. Countable Controlled Substance Book

21. Legal Document • No white out • Blue or black pen only • No cross outs except simple line with word error and your initials • No post-its, paperclips or rubber bands to mark pages • Never skip pages • Never remove pages • Return to program nurse for storage when completed

22. Index Pages • All new medications must be added • Update page numbers as medications are transferred from page to page • Use it each time you do a 1 Person or 2 Person count • Your reference to be sure no countable medications are missing

24. Medication Pages • One page per student’s medication • Only one medication per page • When the page is full, transfer the medication to next empty page

28. Verification Pages • Signatures verify that all counts are correct • Signed after 2 Person counts completed • Signed after all 1 Person counts are completed

31. Diastat Verification Indicate the amount of Diastat present on the student’s Diastat medication page in the Countable Controlled Substance Medication Book each time the daily Diastat checks are completed

33. Other Safety and Security Procedures

34. Staff personal medications must be kept is a secure place, not in a purse sitting on a chair • Contact the Director of Health Services, Program Nurse or Nurse On-Call any time there is a question, concern or something is unclear or out of the ordinary • Immediately report all discrepancies or errors, remember the person who may be harmed if not taken care of is the student

35. Thank you for your diligence and thoroughness in medication administration !!